A Note from Dr. Potter on BIA-ALCL

Elisabeth Potter, MD | Plastic SurgeonTextured Breast Implants and BIA-ALCL

A number of reports have recently hit the news circuit regarding the safety of breast implants and an increasing number of breast  implant-associated anaplastic large cell lymphoma (BIA-ALCL) cases. With an initial 64 incidences, the FDA first identified the connection between breast implants and BIA-ALCL in 2011. The FDA has received documentation of at least 457 patient diagnoses of implant associated ALCL including nine deaths. Breast implants – specifically those with a textured surface – have become the object of much scrutiny.

What is BIA-ALCL?

BIA-ALCL is a form of non-Hodgkin’s lymphoma. It is a cancer of the immune system and not of the breast tissue. As the FDA and other worldwide health agencies gathered and studied data on this disease over the last several years, an association between textured implants and breast implant associated ALCL emerged. Current literature reports that between 1 in 3817 and 1 in 30,000 women will develop this type of lymphoma within the scar capsule adjacent to textured implants.

What Specifically Causes BIA-ALCL?

The FDA and scientists worldwide are  investigating the direct link between implants and BIA-ALCL. Although there are cases of BIA-ALCL in women with smooth implants, the data suggest that the vast majority of cases occur in women with textured implants. Methods used to create a textured implant have been explored as a possible risk factor. In my own experience, textured implants create a more adherent capsule around the breast implant differing from the capsule around a smooth implant. Specifically, the capsule around a textured implant adheres more strongly to the surrounding tissue. There may be an interaction between the immune system and this textured capsule that contributes to the disease. With time and research, we will learn more about its origin.

What Has Been My Experience with BIA-ALCL?

If you saw the recent report on BIA-ALCL on CBS This Morning, you know that one of my patients was diagnosed with this type of non-Hodgkin’s lymphoma. She’d had implants for over 20 years, experiencing no real issue until she developed unexplained hardness and swelling.  After removal and subsequent reconstruction, her pathology unexpectedly showed that her disease had infiltrated her breast tissue. My exact words in the CBS interview were, “ . . . I was astonished. I actually thought it was incorrect.”  When I reexamined her pathology and recognized that her cancer was spreading beyond the capsule, I immediately contacted the rest of her treatment team. But her disease was progressing rapidly. She developed an odd pain in her jaw which eventually led to the discovery that her BIA-ALCL had actually become metastatic – meaning it had spread to other parts of her body. But to say that we were shocked is simply a gross understatement. While many patients diagnosed with BIA-ALCL are “cured” once the implants are removed, my patient’s metastatic case required five rounds of chemo and a stem cell transplant before she was declared in remission.

What Patient Approach Should be Taken with BIA-ALCL?

For anyone thinking about breast augmentation or breast reconstruction, it is your right to be fully informed of the risk, benefits and alternatives of the procedures you are considering. As a doctor, I believe it’s my responsibility to provide my patient with all the information needed to make the best decision possible for her health and wellness. When it comes to breast implants, I want to make sure that my patients are counseled completely before having an implant placed. As I mentioned on CBS This Morning, “The power should be in the woman’s hands. Let’s give her the information and let her choose . . . . This [textured] implant carries greater risk. Would you like it in your body? It’s that simple.”

Are You at Risk for BIA-ALCL?

In general, breast implants should be replaced about every 12 years. If you develop pain, redness or swelling around your breast implant, you should notify your plastic surgeon immediately. If you have swelling, your doctor may obtain an ultrasound to look for fluid around your breast implant and send a sample of fluid for study. This test can help identify BIA-ALCL. I also urge all breast implant patients to refer to the cards given to them by their surgeons at the time of original implant placements. On it, you will find the information needed when reporting any concerning symptoms to your doctor. Is the breast implant textured or smooth? Is it filled with saline or silicon? Is it round or teardrop shaped? Who is the manufacturer? What year was it placed? And finally, what is the serial number? This card is also invaluable in case of a recall.

Do You Have Other Options?

Yes! In my practice, we offer both implant reconstruction and natural tissue reconstruction like the DIEP flap. We counsel our patients about both options and are proud to provide both types of reconstruction. When we place implants, we place smooth, round implants rather than textured implants. But many women are also candidates for natural tissue reconstruction that doesn’t use an implant. I have found that many women choose natural breast reconstruction, like the DIEP flap, when offered the option. DIEP flap uses a woman’s own belly fat to reconstruct her breast using a technique called microsurgery. It provides a more natural breast and does not require future replacement surgeries like breast implants do. In addition to creating new breasts, the DIEP flap creates a tightened, flat abdomen. Many of my patients report that they love the “tummy tuck” DIEP flap provides. And, of course, there’s no future worry about BIA-ALCL or other implant complications.

With BIA-ALCL in the news recently, a lot of cosmetic patients have inquired about natural breast enhancement alternatives. For women who have implants and want them removed and not replaced, I carefully evaluate the options. Some patients are candidates for an enbloc resection followed by a reconstructive breast lift. Currently DIEP flap is not performed as a cosmetic procedure, but in the future, I’d love to see more natural breast augmentation procedures for all women. With time, we’ll see how the risks of BIA-ALCL change the plastic surgery industry as a whole.

If you missed these latest BIA-ALCL reports, check out my interviews in SHAPE magazine and on CBS This Morning